Hospital and community health service costs: England and Scotland compared.

In publications which have compared the health expenditure in the component parts of the United Kingdom by applying the Resource Allocation Working Party (RAWP) formula to the health budget of England, Scotland, Wales, and Northern Ireland it has been previously concluded that Scotland''s hospital and community health services expenditure is more than 19% above what would be a fair distribution. It has also been implied that Scotland''s allocation should be cut substantially to improve services in England. On the assumption that the purpose of examining the distribution of the health and community health service budget is to ensure "equal opportunity of access to health care for people at equal risk" it is concluded that simple RAWPing of the United Kingdom budget is flawed and a conclusion based on this is therefore untenable.     

Status of the Hen Harrier Circus cyaneus in the UK and the Isle of Man in 1998

A survey of breeding Hen Harriers in the UK and the Isle of Man carried out in 1998 consisted of two parts: a complete census of 10-km squares at the core of the species'known range, and a random sample of 10-km squares across the rest of its known recent range. From this, the UK and Isle of Man breeding population was estimated at 570 territorial pairs: 436 in Scotland, 19 in England, 28 in Wales, 38 in Northern Ireland and 49 on the Isle of Man. Although there was no overall change in the size of the UK and Isle of Man population between 1988–94 and 1998, numbers declined in Orkney and increased in Northern Ireland. In Scotland, numbers increased on grouse moors and decreased in young plantation between 1988–89 and 1998, so that 55% of the population is now found on grouse moor. A similar situation exists in England, but in Northern Ireland 45% of the population was found breeding in open areas within mature conifer plantations in 1998.     

Status of the Hen Harrier Circus cyaneus in the UK and Isle of Man in 2016

Capsule: The fifth UK and the Isle of Man survey of Hen Harrier in 2016 showed varying trends by country and region.

Aim: To estimate the size of the breeding Hen Harrier population (with associated 95% confidence intervals) in the UK and Isle of Man, constituent countries and Scottish regions, in 2016 and calculate population change over the five surveys to date.

Methods: Complete surveys were made of all 10-km squares likely to be occupied by breeding Hen Harriers in England, Wales, Northern Ireland and the Isle of Man, using standard methods developed for previous national surveys. In Scotland, self-selected 10-km squares were surveyed by volunteers and a stratified random selection of the remaining 10-km squares within the known breeding range was surveyed.

Results: The UK and Isle of Man Hen Harrier population was estimated at 575 territorial pairs (95% confidence limits, 477–694), a non-significant decline of 13% since 2010 but a significant decline of 24% since 2004. Scotland held the majority (80%) of the population with 460 (359–573) territorial pairs. Elsewhere, 46 territorial pairs were recorded in Northern Ireland, 35 in Wales, 30 in the Isle of Man and four in England. Significant decreases were recorded in the number of pairs in Scotland using grouse moor (?57%) and young forest (?54%).

Conclusion: The combined breeding population of Hen Harriers in the UK and Isle of Man has shown a non-significant decline between 2010 and 2016. There were notable decreases in England, Northern Ireland and Wales since 2010.     

Spina bifida and anencephaly in Scotland.

Data obtained from routine sources showed that from 1971 to 1982 the birth prevalences of spina bifida and anencephaly in Scotland fell. When known terminations after routine alpha fetoprotein screening were added to total births the adjusted birth prevalence could be calculated. In 1974-82 this fell by 40% for spina bifida (3 X 0-1 X 8) and 36% for anencephaly (2 X 2-1 X 4). These findings were compared with data on birth prevalences in England and Wales, Northern Ireland, and Glasgow. The fall in birth prevalences of spina bifida and anencephaly over the past decade appears to have been due both to a true fall in incidence as well as to increased screening and termination for these conditions.     

What are health authorities doing about the health problems caused by unemployment?

Unemployment is over three million in Britain, and unemployment is known to be associated with poor health. It has been suggested that health authorities should produce a comprehensive response to the health problems caused by unemployment, and a survey was undertaken to find how many had done so. All the regional and district health authorities in England, the health boards of Wales, Scotland, and Northern Ireland, and the family practitioner committees of England and Wales were asked by letter what they were doing to respond to the health problems of unemployment. A list of suggestions of what they might be doing was enclosed. The overall response rate was 77% (255/331), and 50% (127/255) of the respondents were doing something--33.3% (3/9) of the regional health authorities, 64% (101/158) of the district health authorities and health boards, and 26% (23/88) of the family practitioner committees. The paper describes what they were doing. A relation was sought between the level of unemployment in an area and the extent of the response, and a significant association was found. Half of Britain''s health authorities are now responding in some way to the health problems associated with unemployment.     

Children's participation in healthcare in the UK--gesture,rhetoric, or real involvement?

In the United Kingdom (England, Wales, Scotland, and Northern Ireland) children and their best interests are protected through a range of best practice initiatives, and legislation and guidance at country, national, European, and global levels. Some of the recent commitment by the government may be the result of enlightened thinking, but some of it has resulted from the aftermath of at least two major healthcare incidents. This article reviews the UK's recent national and international efforts to protect its thirteen million children and ensure that their voices are heard.     

Breeding status of Merlins Falco columbarius in the UK in 2008

Capsule The third national Merlin survey estimated a UK population of 1162 breeding pairs (95% CI: 891–1462).

Aims To estimate the number of breeding Merlins (with associated 95% confidence intervals) in the UK and the four countries (Scotland, England, Wales and Northern Ireland), and to compare these with the relevant estimates from the 1993–94 Merlin survey. In addition, to calculate estimates of change for several regional populations with complete survey coverage during both national surveys.

Methods A subset of 10-km squares (Raptor Study Group squares and randomly sampled squares) was surveyed across the breeding distribution of Merlins in the UK using standardised methods devised during the 1993–94 national survey.

Results The population estimate for Merlins in the UK was 1162 breeding pairs, and in Britain was 1128 pairs (95% CI: 849–1427), which although 13% lower, was not significantly different from the British estimate of the 1993–94 survey. Scotland held the bulk (733 pairs) of the UK Merlin population, and smaller numbers of 301 pairs, 94 pairs and 32 pairs were estimated for England, Wales and Northern Ireland, respectively. The population estimate for Wales may have been biased upwards by low coverage in the south of the country. Marked declines were noted in several regional Merlin populations, particularly in areas of northern England.

Conclusions The 2008 Merlin survey suggests that the population in Britain has remained relatively stable since 1993–94, but with local declines, particularly in northern England. Currently, little is known about important drivers of regional population change in Merlins, but changes in land-use, prey populations and climate are likely to be important factors.     

Geochemistry and health in the United Kingdom.

Before the 1960s, comparisons between the distribution of trace elements in the environment and health in the United Kingdom were primarily confined to ad hoc studies in areas associated with particular agricultural disorders or with unusual human mortality or morbidity records. More recently, increasing interest in the importance of trace elements in crop and animal production and in the hazards of environmental pollution have created a need for more systematic geochemical data. Geochemical reconnaissance maps for England, Wales, Northern Ireland and parts of Scotland have demonstrated the extent of many known clinical trace element problems in agriculture and have also been valuable in delineating areas within which subclinical disorders may occur. Their application to studies on the composition of soils, food crops and surface waters in relation to public health has proved encouraging. Current knowledge and present investigations into environmental geochemistry and human health in the U.K. are reviewed, together with future research requirements.     

Hospital visiting hours: time for improvement

In a survey of hospital visiting hours in general medical and surgical wards throughout the United Kingdom a pattern of visiting emerged showing that many hospitals still have very restricted visiting. A quarter of the 404 hospitals that responded permitted visiting for an average of two hours a day or less. In contrast, just over a third of hospitals allowed visiting for more than five hours a day. There was no relation between visiting times and type of hospital, but a striking regional variation in visiting hours was found, with more liberal visiting in south east England and restricted visiting in northern England, Scotland, Wales, and Northern Ireland.     

The status of the Hen Harrier,Circus cyaneus,in the UK and Isle of Man in 2010

Capsule The fourth national survey of Hen Harrier showed that the population in the UK and the Isle of Man declined significantly between 2004 and 2010.

Aim To estimate the size of the breeding Hen Harrier population (with associated 95% confidence intervals) in the UK and Isle of Man, constituent countries and Scottish regions, in 2010 and calculate population change since previous surveys in 1998 and 2004.

Methods Complete surveys were made of 10-km squares likely to be occupied by breeding Hen Harriers in England, Wales, Northern Ireland and the Isle of Man, using standard methods developed for previous national surveys. In Scotland, a ‘census’ area was non-randomly selected for survey by volunteers, and randomly selected squares were surveyed in two strata covering the rest of the known range.

Results The UK and Isle of Man Hen Harrier population was estimated at 662 territorial pairs (95% confidence interval (CI): 576–770), a significant decline of 18% since 2004. Scotland holds the bulk (76%) of the population (505 territorial pairs; 95% CI: 417–612), with smaller numbers in Northern Ireland (59 pairs), Wales (57 pairs), the Isle of Man (29 pairs) and England (12 pairs). Declines of 49% and 20% were observed in the Isle of Man and in Scotland, respectively, whereas the Welsh population increased by 33%. A significant decrease was recorded in numbers of pairs using young and mature plantation forest in Scotland.

Conclusion The breeding population of Hen Harriers in the UK and Isle of Man declined between 2004 and 2010. Notable decreases in Scotland and the Isle of Man may be related to habitat change and illegal persecution. Illegal persecution continues to limit the population size of harriers in England to very low levels.     

Child Deaths Due to Injury in the Four UK Countries: A Time Trends Study from 1980 to 2010

Background

Injuries are an increasingly important cause of death in children worldwide, yet injury mortality is highly preventable. Determining patterns and trends in child injury mortality can identify groups at particularly high risk. We compare trends in child deaths due to injury in four UK countries, between 1980 and 2010.

Methods

We obtained information from death certificates on all deaths occurring between 1980 and 2010 in children aged 28 days to 18 years and resident in England, Scotland, Wales or Northern Ireland. Injury deaths were defined by an external cause code recorded as the underlying cause of death. Injury mortality rates were analysed by type of injury, country of residence, age group, sex and time period.

Results

Child mortality due to injury has declined in all countries of the UK. England consistently experienced the lowest mortality rate throughout the study period. For children aged 10 to 18 years, differences between countries in mortality rates increased during the study period. Inter-country differences were largest for boys aged 10 to 18 years with mortality rate ratios of 1.38 (95% confidence interval 1.16, 1.64) for Wales, 1.68 (1.48, 1.91) for Scotland and 1.81 (1.50, 2.18) for Northern Ireland compared with England (the baseline) in 2006–10. The decline in mortality due to injury was accounted for by a decline in unintentional injuries. For older children, no declines were observed for deaths caused by self-harm, by assault or from undetermined intent in any UK country.

Conclusion

Whilst child deaths from injury have declined in all four UK countries, substantial differences in mortality rates remain between countries, particularly for older boys. This group stands to gain most from policy interventions to reduce deaths from injury in children.     

Is the money following the clients with learning disabilities?

For the past decade patients with learning disabilities living in long stay mental handicap hospitals have been resettled in the community. Local authorities have also taken on the care of new patients who would once have been long stay residents. The imperfect data that are available suggest that in England about half the residents in mental handicap hospitals in 1981 are now the responsibility of local authorities; the figures for Wales and Northern Ireland are 38% and 33%. Data on revenue suggest that the savings to the health service are much less--perhaps 9% in Northern Ireland and 3.6% in England, although there have also been capital gains through the sale of hospitals. Existing methods of transferring money from health to local authorities--joint finance and "dowries" for individual patients--do not seem adequately to have compensated local authorities. Moreover, as patients still to be transferred are more severely disabled local authorities will require larger sums--about 26 000 pounds per patient per year plus 39 200 pounds in capital. If the government chooses not to transfer these resources from health authorities it will be switching funds away from learning disabled people to other care groups.     

The population status of breeding Twite Linaria flavirostris in the UK in 2013

Capsule: The second national survey of Twite Linaria flavirostris estimated a UK breeding population of 7831 pairs (95% confidence limits: 5829–10?137) in 2013.

Aims: To estimate the breeding population size of Twite in the UK and constituent countries and to calculate change since the 1999 survey.

Methods: Counts of Twite were made on three visits between May and July across a stratified random sample of 1-km squares in England, Scotland and Wales. In Northern Ireland, a complete census was made of the known range and adjacent 1-km squares with suitable habitat. Field surveys involved walking line transects 200 m apart and, in suitable nesting habitat, making 5-minute stops at 100 m intervals to scan and listen for Twite.

Results: The UK population of Twite was estimated at 7831 pairs (95% CL: 5829–10?137). This was 21% lower but not significantly different from the 1999 survey estimate. Scotland held 98% of the UK population (7640, 95% CL: 5629–9954). There were an estimated 164 pairs (95% CL: 76–297) in England, a significant decline of 72% from 1999. Estimated totals for Wales and Northern Ireland were 16 (95% CL: 10–24) and 18 pairs respectively.

Conclusion: The second national survey suggests a moderate decline in the UK Twite population since 1999 but with considerable variation between countries. Further work is required to understand the drivers of population change across breeding populations.     

What kind of mixed race/ethnicity data is needed for the 2020/21 global population census round: the cases of the UK,USA, and Canada

In western countries the mixed race/ethnicity population is experiencing a rapid increase in numbers and growing diversity, raising challenges for its capture in censuses and surveys. Methods include exact combinations of interest, multi-ticking, and open response, as exemplified by the censuses of England and Wales, the USA and Canada, and Scotland and Northern Ireland, respectively. However, investigations of question face validity, reproducibility of findings, and efficacy of capture reveal quality problems with all three approaches. The low reporting reliability of this population urgently requires research and testing to identify optimal strategies. While there is clearly no one gold standard method of capture and current approaches have developed within national contexts, it is timely to review these methods across the three countries and to make recommendations for the upcoming 2020/21 censuses.     

Trends in incidence of,and mortality from,cervical lesions in Ireland: Baseline data for future evaluation of the national cervical screening programme

AimTo investigate incidence and mortality trends for cervical lesions in Ireland in the period 1994–2008.MethodsWe used data from the National Cancer Registry, Ireland and national death registration data to calculate age-standardised rates for the periods of interest. We used standardised rate ratios to test whether incidence was associated with socio-demographic variables and used Joinpoint to examine trends by morphology grouping.ResultsIncidence of cervical cancer and cervical intraepithelial neoplasia (CIN3) rose over the period 1994–2008. The annual percentage change for cervical cancer was 1.8% and that for CIN3 was 3.8%. Women resident in the most deprived areas had invasive cervical cancer incidence almost twice as high as those resident in the least deprived areas (standardised rate ratio (SRR) = 1.8). Comparing incidence in Ireland to England and Wales, Northern Ireland and Scotland in the three years 2005–2007, the SRRs (other areas vs. Ireland) were 0.70, 0.88 and 0.84 respectively. Cervical cancer rates have fallen in these countries in the same period that there is a rise demonstrated in Ireland.ConclusionIncidence rates of cervical cancer rose in Ireland steadily, albeit modestly, during 1994–2008, most likely due to long-term changes in patterns of sexual behaviour and contraceptive use. A more pronounced rise in CIN3 rates point to considerable levels of opportunistic screening during this period. Mortality rates have changed little over the past four decades, in contrast to trends in countries with well-organised screening programmes.     

Emergence of cold water strawberry disease of rainbow trout Oncorynchus mykiss in England and Wales: outbreak investigations and transmission studies

Cold water strawberry disease (CWSD), or red mark syndrome (RMS), is a severe dermatitis affecting the rainbow trout Oncorynchus mykiss. The condition, which presents as multifocal, raised lesions on the flanks of affected fish, was first diagnosed in Scotland in 2003 and has since spread to England and Wales. Results of field investigations indicated the condition had an infectious aetiology, with outbreaks in England linked to movements of live fish from affected sites in Scotland. Transmission trials confirmed these results, with 11 of 149 and 106 of 159 naive rainbow trout displaying CWSD-characteristic lesions 104 to 106 d after being cohabited with CWSD-affected fish from 2 farms (Farm B from England and Farm C from Wales, respectively). The condition apparently has a long latency, with the first characteristic lesions in the previously naive fish not definitively observed until 65 d (650 day-degrees) post-contact with affected fish. Affected fish from both outbreak investigations and the infection trial were examined for the presence of viruses, oomycetes, parasites and bacteria using a combination of techniques and methodologies (including culture-independent cloning of PCR-amplified bacterial 16S rRNA genes from lesions), with no potentially causative infectious agent consistently identified. The majority of the cloned phylotypes from both lesion and negative control skin samples were assigned to Acidovorax-like beta-Proteobacteria and Methylobacterium-like alpha-Proteobacteria.     

Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995.

OBJECTIVE--To assess the prevalence of antibiotic resistance and serotype distribution among pneumococci in England and Wales in 1990 and 1995. DESIGN--Observational surveys in March 1990 and March 1995. During two weeks in each survey period all pneumococci isolated in public health laboratories in England and Wales were collected and assessed for sensitivity to antibiotics and the distribution of serogroups or serotypes. SETTING--The network of public health laboratories throughout England and Wales. SUBJECTS--1127 individual patient isolates of Streptococcus pneumoniae obtained during the two surveys. MAIN OUTCOME MEASURES--Sensitivity or resistance to a range of antibiotics; serogroup or serotype. RESULTS--The prevalence of intermediate or full resistance to penicillin increased from 1.5% in 1990 to 3.9% in 1995 and resistance to erythromycin increased from 2.8% to 8.6%. About 92% of isolates belonged to serogroups or serotypes included in the currently available pneumococcal vaccine. CONCLUSION--Resistance to penicillin and erythromycin has increased among pneumococci in England and Wales. Continued surveillance to assess further increases in the prevalence of pneumococcal resistance to antibiotics is essential.     

The U.K. Acid Waters Monitoring Network: an assessment of chemistry data, 1988–93

1. The current extent and distribution of acidified surface waters in the U.K. is assessed using data collected between 1988 and 1993 as part of the U.K. Acid Waters Monitoring Network (AWMN). The data have been collected against a background of constant S deposition across the U.K. throughout the monitoring period. 2. Surface waters with mean pH < 5.0 occur in south-west Scotland, south-east Northern Ireland, the Lake District and south-east England. In addition, sites with mean pH < 5.5 are found in central and north-east Scotland, the Pennines and north Wales. These areas receive, and have historically received, high levels of S deposition and xSO₄ is identified as the main contribution to non-marine acid anion concentrations. 3. Mean total oxidized nitrogen (TON) concentrations are > 10 μeq l^–1 at ten of the twenty-two sites which are found in areas broadly corresponding to areas of high N deposition. The mean contribution of TON to total non-marine acid anion concentration is > 10% at sixteen sites and > 20% at six sites. Most sites, except for those with TON < 10 μeq l^–1 and mainly located in north-west Scotland and Northern Ireland, demonstrate strong seasonality in TON concentrations and during autumn and winter instantaneous contributions of TON to total non-marine acid anions is up to 60%. This confirms the importance of N with respect to surface water acidification and strengthens the case for implementation of controls on future N emissions. 4. The data period is currently too short for rigorous trend analysis given the monthly/quarterly sampling frequency in streams/lakes, respectively. Nevertheless, increased SO₄ and xSO₄ can be observed in the time series at sites in south-west Scotland and north Wales despite constant deposition to these areas. Similar trends are evident in longer-term more frequent data at two sites and may reflect hydrometeorological influences, especially the duration and intensity of hot and dry weather in summer which promotes mineralization of organic S.     

Invasive fish species in the largest lakes of Scotland,Northern Ireland,Wales and England: the collective UK experience

An invasive species is defined as an alien (or introduced or non-native) species whose establishment and spread threaten ecosystems, habitats or species with harm. Such threats to UK lake fish communities have long been appreciated and this review assembles case histories, including new data, from the largest lakes of Scotland, Northern Ireland, Wales and England to examine the hypothesis that at least some of these introductions have become invasive. Loch Lomond in Scotland has experienced six introductions [chub (Leuciscus cephalus), common bream (Abramis brama), crucian carp (Carassius carassius), dace (Leuciscus leuciscus), gudgeon (Gobio gobio) and ruffe (Gymnocephalus cernuus)], of which the most significant has been that of the percid ruffe, which has been implicated in a recent decline of the native coregonid whitefish (Coregonus lavaretus). In Northern Ireland, the introduction of the cyprinid roach (Rutilus rutilus) to Lough Neagh has apparently had a negative impact on some overwintering waterfowl, although the native coregonid pollan (Coregonus autumnalis) remains abundant. Llyn Tegid in Wales has received three introductions [rudd (Scardinius erythrophthalmus), ruffe and silver bream (Blicca bjoerkna)], although no impacts on the native whitefish or other fish populations have been observed. In England, individuals of at least 12 native and non-native fish species have been brought to Windermere for the purpose of live-baiting, although only those of the cyprinids roach and common bream have established abundant populations. At the same time, the native salmonid Arctic charr (Salvelinus alpinus) has declined markedly while the native esocid pike (Esox lucius) has shown changes in abundance, distribution and individual condition, although these developments have not been shown to be causally linked. None of these introductions were sanctioned by appropriate fisheries or other regulatory bodies and almost all of them probably arose from the release or escape of live-bait used by pike anglers. Of the 10 species introductions documented here, four (common bream, gudgeon, roach and ruffe) have established abundant populations and two of these (roach and ruffe) have apparently caused or currently threaten harm, supporting the hypothesis that at least some of these introductions have become invasive.     

Survey of safety and health care in British medical laboratories.

A retrospective postal survey of 24 000 medical laboratory workers in England, Wales, and Scotland showed highly variable standards of safety and health care. Pre-employment health screening was offered to two-thirds of employees, the physicians being the least likely to be examined (15%). Scottish laboratories provided better safety control than English and Welsh laboratories, while Public Health Service Laboratories had a better record than National Health Service establishments. Mouth pipetting is still practised in 65% of English and Welsh laboratories, and the use of protective clothing is rarely compulsory. The servicing of safety cabinets is often inadequate. Known and suspected carcinogens are still apparently used in a few laboratories (2-10%). In view of the wide variation in standards among laboratories, urgent consideration should be given to establishing regulations for codes of safe practice rather than relying merely on recommendations as at present.